It was Saturday night and the room was packed with coaches. Not ordinary coaches. These men and women, all black belts, knew thousands of ways to subdue, disable, and even kill an attacker with their bare hands. But they were about to learn about a new attacker, and what they had to know to stop this killer before it got to them and the ones they cared about.
My name is Chris Martin and it has become my mission to educate coaches and students of Brazilian Jiu Jitsu (BJJ) on risks of developing a stroke while practicing jiu jitsu.
On October 19th, 2019 in Phoenix, AZ at the AZ BJJ Federation Coaches Meeting I spoke about Awareness Of The Risks of Strokes When Practicing Brazilian Jiu Jitsu.
The room full of Black Belts had no idea that artery dissections in the neck could cause a stroke. We were presenting the idea that according to our data there is an increased risk of developing a stroke from practicing Jiu Jitsu in relatively healthy young people.
For those new to the blog, dissection of the artery means a tear in the lining of the artery. The blood supply to the brain mainly flows through two pairs of arteries: the carotid arteries and the vertebral arteries. Most chokes in jiu jitsu work by compressing the larger carotid arteries which slows or stops the flow of blood and therefore oxygen to the brain, causing the choked person to pass out or forcing them to tap before they do. Due to the massive stresses on the head and neck during jiu jitsu it is also possible for the smaller, more protected vertebral arteries to be damaged (dissected).
Damage to the arteries and can cause a stroke in multiple ways.
If the dissection is severe enough on its own to limit blood flow to the brain, that lack of oxygen can cause a stroke. Alternatively there can be a dissection which the body attempts to heal. When you get a cut on your skin the body forms a scab to seal the area until scar tissue can fill in the wound. In a similar fashion, when an artery is damaged the body will form a clot over the damaged area until scar tissue can heal it. If that clot breaks free on its own or during training it can be pushed into the brain where it clogs smaller blood vessels, blocking the blood flow, and causing a stroke.
Over the last few years at least 65 of us BJJ practitioners have suffered a stroke due to training and the list is continuing to grow.
Like many others, I had no idea that something like a stroke was even possible in my sport either. To be quite honest, I really never even knew what a stroke was. And neither did Jason, a 7 year practitioner of BJJ who I interviewed from his hospital bed just weeks before I left to this conference :
“When I went into rolls and when I was doing the fist bump I had no idea that that was the decision tree. They almost lead you to believe, or I believed, let’s put it that way, let’s just say that… that I believed that the decision was: If you get into a choke you can “go out” (or) you can try to escape, try to get out of the choke, and fight on. There’s not a lot of discussion about strokes and emergency rooms, large bills, and all this other stuff.”
I was not the only one clueless to this risk. After this interview with Jason went viral , Jason’s coach coach Jay Bell posted Jason’s interview on his personal Facebook page :
So far in all of my interviews with other BJJ stroke survivors , none of them knew that a stroke could happen in our sport until it happened to them. Well, that is not 100% accurate. Josh Verra, a BJJ black belt who also works in the medical field as an ERPA (Emergency Medical Physicians Assistant), said that he did know that artery dissection was a very real possibility in Jiu Jitsu, but he says, “I never thought it would happen to me”.
Josh and I connected with each other after he had his stroke in Jan of 2019 due to a vertebral artery tear from BJJ.
Fortunately Josh was able to join me in AZ to share our stories as well as the stories of the many individuals whose cases continue to surface in the message boxes my of Facebook, Instagram, email, and Reddit forums almost daily. Our list as of today has accumulated above 65.
Josh and I are continuing to spread stroke awareness by sharing our stories and the stories of all the stroke survivors to other coaches and BJJ students throughout the world.
Regarding strokes and BJJ we hope that coaches and students will take time to educate themselves on some of the important but mostly unknown aspects of the situation, namely:
Strokes can and do happen in our sport.
Just realizing and accepting the fact that this can happen is the first step in prevention. As much as we (BJJ lovers) would like to believe that jiu jitsu would never cause something like a stroke, Josh and I have created a study of cases of strokes from BJJ and as of today our list keeps growing. The majority of the doctors who are treating patients (post stroke) are confirming that the strokes are the result of the chokes — over 80% if those strokes are caused by dissections .
2) Recognize the signs.
The most common signs of a stroke reported by BJJ practitioners are blurred vision, loss of balance, problems speaking, memory loss or comprehension issues, loss of feeling in the arms or legs, and massive headaches.
Because most BJJ practitioners are not aware strokes can happen, it follows that they are also clueless when it comes to the signs and symptoms of a stroke.
One of the most important topics that Josh and I shared is the importance of knowing the signs of the stroke and knowing what we need to look for with our teammates who might be having a stroke but do not know it.
We ourselves need to recognize the difference between a stroke and “just feeling a bit dehydrated”, which are drastically different.
3) Making the Call!
When it comes to strokes, time is important: there is a small 3–6 hour window after the beginning of a stroke where doctors can treat a stroke so that there is not too much permanent damage to the brain. If the stroke is treated quickly and effectively patients have a better chance of making a full recovery.
After you recognize the signs, you must take the initiative to get the patient to the hospital even if they tell you, “NO”. More than likely the practitioner having the stroke has NO idea what is happening and will rationalize everything else but a stroke and deny any type of treatment.
The worst thing you can do is let them go home or drop them anywhere else expect the hospital.
Really, the best thing that you can do is call the ambulance.
4) Be The Advocate at the hospital.
Explain the neck trauma of BJJ to the medical team.
Not many medical professionals are familiar with BJJ. More than likely they will even confuse Jiu Jitsu with karate and be completely ignorant of the fact that we are literally choking each other out for sport sometimes 21 days out of a month.
Because of this we need to explain to the medical people all the details about the patient they are viewing, which 100% must include that we “practice Brazilian Jiu Jitsu which means that our necks are being twisted, manipulated, compressed, and sheared on a frequent basis in practice and in competition .”
Often the chief complaints of the patient are blurred vision, loss of balance, problems speaking, memory loss or comprehension issues, loss of feeling in the arms or legs, and massive headaches. Because most BJJ practitioners are younger and/or healthier individuals, most medical professionals are not looking into the possibility of a stroke as the cause of the symptoms.
We have found that many BJJ stroke patients are being misdiagnosed because the medical people are not ordering the right scans. If the imaging scan does not use contrast in the imaging it will not pick up a dissection as it relates to CAD or VAD.
Because the dissections are not being detected by the tests that are ordered, many times the patients are sent home with a diagnosis of “dehydration”, “virus”, or “migraines”. This puts an enormous emphasis on the importance of communication to the medical professionals: we need to explain clearly what BJJ is and how our necks are involved.
The good news is if we accept that strokes can happen in our sport, if we are aware of the signs and symptoms of a stroke, if we quickly call 911, and if the medical staff is aware of the possibility of a stroke and scans for one and treats an actual stroke correctly, there is a good chance that with the proper care the BJJ practitioner can make a nearly full recovery.
As many of you are aware, after my stroke I was paralyzed and unable to speak. Now I am actively rolling again and giving speeches to rooms full of people.